Heat-Related Illness Not as Simple as It Looks

​Heat-related illness should be an easy diagnosis, but it is not that simple, and there are a number of tripwires.The common pathophysiology for most heat-related illnesses is heat generated from muscular activity that accumulates faster than can be dissipated via increased skin blood flow and sweating, resulting in exertional hyperthermia. Part of the challenge for clinicians is that heat illness is a continuum with a significant overlap of signs and symptoms. Granted, heat rash, heat cramps, and heat edema aren't that confusing, but diagnostic accuracy can be a little more challenging at the other end of the spectrum.Syncope, a diagnostic element of heat syncope, a milder form of heat-related illness, can also occur in heat exhaustion and heat stroke. (Wilderness Environ Med. 2014;25[4 Suppl]:S55.) Altered mental status is the defining symptom of heat stroke, but heat exhaustion and heat syncope also can have brief periods of altered mental status. Other minor neurological signs and symptoms, including dizziness, anxiety, vomiting, headache, and fatigue, also occur across the heat illness spectrum. An elevated temperature also occurs across the spectrum of heat illness.The diagnosis of heat stroke depends on only two of the multiple signs and symptoms associated with this condition: a core temperature of higher than 40°C and CNS abnormalities such as the three Cs (confusion, convulsions, and coma). The documented temperature should be a esophageal or rectal tempe...
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